Case management: effects of improved risk and value information

The purpose of this study was to determine the impact on resource use of providing case managers with information on the potential for patients to benefit from home care services.

Twenty-four case managers working in the Arizona Long Term Care System (ALTCS) were randomized into treatment and control groups. Members of the treatment group were given patient assessments for 25 ALTCS clients, estimates of the patients' risks for various adverse outcomes, and estimates of the aggregate potential benefit for each patient. Members of the control group were given only patient assessments (as is usual practice) for the same sample of 25 clients. Both groups were asked to independently write nonbinding care plans for each patient. The cost of each case manager's care plans was computed by multiplying standard costs per service times the mix and volume of services prescribed for each patient.

Treatment group care plan costs were, on average, lower than control group costs and closely tracked variation in estimated patient risks. Comparison group care plan costs were unrelated to risks.

Information about risk and potential benefit can improve targeting of services to long-term-care clients. A prospective study using such an approach is warranted to see if provision of risk and potential benefit information would produce better clinical and economic outcomes.